Classroom Training ONLY - 30-Hour

Credit Card Check payment (Payment required for every order, must receive within 48 hours for order to be complete. We are unable to hold a seat if not received within 48 hours. )

Dates

July 8 - 11, 2019 July 15 - 18, 2019

Dates

July 08 - 11, 2019 -- Full Payment
$
250.00

July 08 - 11, 2019 -- 50% Payment
$
125.00

July 15 - 18, 2019 -- Full Payment
$
250.00

July 15 - 18, 2019 -- 50% Payment
$
125.00

Total
$
0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

General Information

Parent/Guardian (if applicable)

First Name Last Name

Address
*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Phone Number
*

-
Area Code Phone Number

E-mail
*

Student Information

Driver's Name
*

First Name Last Name

Birth Date
*

Month Day Year

School Name

Grade

Gender
*

Male Female

Student Permit/License #
*

If they don't have permit yet type N/A

Expiration Date

/
Month
/
Day Year

Date Date Picker Icon

Student's Phone

-
Area Code Phone Number

Does the driver have any special accommodations we should be aware of (504 Plan, IEP, etc.)? If yes, please describe.
*

Special Accommodations Information

Refund Policy

Towne Lake Driving School does not offer refunds. All contracts are good for one (1) year.

Confirmation

BY CLICKING THE SUBMIT BUTTON, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. I ALSO CONFIRM THAT I AGREE WITH TOWNE LAKE DRIVING SCHOOL'S PRIVACY POLICY.